EP1463466B1 - Accessoire pour l'implantation d'une endoprothese de la hanche - Google Patents

Accessoire pour l'implantation d'une endoprothese de la hanche Download PDF

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Publication number
EP1463466B1
EP1463466B1 EP03702385A EP03702385A EP1463466B1 EP 1463466 B1 EP1463466 B1 EP 1463466B1 EP 03702385 A EP03702385 A EP 03702385A EP 03702385 A EP03702385 A EP 03702385A EP 1463466 B1 EP1463466 B1 EP 1463466B1
Authority
EP
European Patent Office
Prior art keywords
manipulation
cup
aid according
alignment
guide
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP03702385A
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German (de)
English (en)
Other versions
EP1463466A2 (fr
Inventor
Reinhard Graf
Martin Imhof
René Brack
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Smith and Nephew Orthopaedics AG
Original Assignee
Smith and Nephew Orthopaedics AG
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Filing date
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Publication of EP1463466A2 publication Critical patent/EP1463466A2/fr
Application granted granted Critical
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684—Trial or dummy prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/1746—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for the acetabulum
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4609—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of acetabular cups
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/067—Measuring instruments not otherwise provided for for measuring angles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/34—Acetabular cups
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3611—Heads or epiphyseal parts of femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3625—Necks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4668—Measuring instruments used for implanting artificial joints for measuring angles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering

Definitions

  • the invention relates to an aid for implantation of a hip joint endoprosthesis according to the preamble of claim 1.
  • Such a tool is from the US-A-6,102,915 known, where there is the manipulation pan at the same time the milling tool and the means for holding the aligned position of the manipulation pan is formed by nails.
  • the surgeon must perform various operations using tools in the insertion of hip endoprostheses, and in particular the natural acetabulum with the separate milling tool to obtain a bearing shell, in which an artificial hip socket can be anchored.
  • a pan impact instrument is used. In both tools, the surgeon must pay attention to the most accurate alignment of the tools so that the intended positioning of the acetabular cup can be achieved as accurately as possible.
  • the present invention seeks to provide an aid for implantation of a hip joint endoprosthesis, which with simple mechanical Means an exact positioning of the acetabulum in relation to the femur or to the anchored in the femur condyle allowed. Care must be taken that the pan is implanted so that any conceivable movement of the femur a collision between the edge of the pan and femoral neck is avoided.
  • the manipulation cup is brought into a position in which a collision between the opening edge of the acetabulum and the femoral neck is reliably avoided after the final implantation of the hip joint endoprosthesis.
  • the aforementioned shoulder on the manipulatory joint head can also be defined by shoulder portions distributed approximately uniformly over the circumference. These sections could be replaced in extreme cases by pin-like projections. Of course, then, a sufficient number of protrusions are needed to achieve the above-described alignment of the manipulation cup.
  • the bone fixable guide rod which corresponds to a arranged on the manipulation pan guide means.
  • the guide rod can be designed either as a nail or as a threaded rod. In the latter case, the guide rod on the anchored in the bone end portion of a screw thread, so that it is screwed into the bone, namely pelvic bone.
  • the management device associated with the guide rod on the manipulation pan preferably comprises a component connected to the manipulation cup via an arm, in particular a guide block or a guide sleeve with a bore for receiving and guiding the guide rod. Accordingly, after Orientation of the manipulation pan of the guide rod passed through the guide bore in the arranged on the manipulation pan guide means and anchored in the bone. Subsequently, the manipulation pan is removed from the guide rod. The guide rod is then free for fastening, in particular for pushing on a jig for aligning a milling head or its drive axis so that the alignment of the milling head corresponds to that of the manipulation pan. If only one single guide rod is arranged, the alignment gauge is preferably also pivotable about it.
  • the Ausrichtlehre comprises a slidable on the guide rod arm, in particular bracket, at its free, i. the guide rod opposite end of a straightening plate, in particular provided with markings straightening plate for aligning the cutter drive axis is arranged, for aligning the cutter drive axis this is pivoted in full or gap-free contact with the straightening plate and possibly even parallel to this.
  • the markings preferably still provided on the straightening plate allow the milling cutter drive axis to be pivoted parallel to the straightening plate into a position corresponding to a predetermined marking, in particular predetermined zero position. This zero position can be assigned two maximum tolerance positions of ⁇ 5 °.
  • the cutter drive shaft is provided with a rotating sleeve, rotatably mounted within the cutter drive shaft and on the directional plate are held during the milling in gap-free system can.
  • the manipulation cup can also be provided with a guide device for two or more guide rods which can be fixed parallel to one another in bone.
  • the Ausrichtlehre for the milling head or its drive axis and the pan-driving instrument then also has two or three corresponding through holes for sliding onto the fixed in the bone guide rods.
  • a further embodiment of the first embodiment is characterized in that the straightening plate of the alignment gauge is bent in a U-shape, wherein the space between the two plate legs serves to receive the cutter drive axis, preferably for substantially free of play receiving the same, so that the surgeon only have to make sure that the cutter drive axis is in zero position parallel to the straightening plate.
  • the upper panel side facing the surgeon can be provided with indentations on the front side, which serve as markings for aligning the milling cutter drive axis parallel to the alignment plate.
  • a further embodiment of an aid according to the invention is characterized in that serve as a means for aligning the manipulation pan in the acetabulum optical detection means, for example in the form of extending over the circumference of the spherical part of the manipulatory joint head notch or groove.
  • a marking line can also be provided.
  • the mentioned mark extends within a plane that either extends perpendicular or at a predetermined angle to the condyle center axis.
  • the manipulation cup is then properly aligned when the mark is visible over the edge of the manipulation cup.
  • the orientation of the manipulation cup is anatomically correct if the marking is no longer recognizable on all sides, ie beyond the circumference of the manipulation cup.
  • the manipulating condyle is mounted on the neck of a manipulating rasp so that the condyle center axis coincides with the neck axis.
  • a third embodiment serves as a means for aligning the acetabulum manipulation pan extending in a plane perpendicular to the condyle center axis circumferential shoulder in conjunction with an obliquely to the condyle center axis extending receptacle for the neck of a Manipulierraspel whose longitudinal axis extends parallel to the femoral neck axis ,
  • the manipulation cup is aligned correctly in this embodiment, when the peripheral shoulder of the manipulating condyle is flush with the outer peripheral annular surface of the manipulation pan.
  • a means for holding the aligned position of the manipulation pan and separate fixing rods can serve, which extend through a holding device for the manipulation pan.
  • the fixation rods are provided with screw threads at the end sections anchored in the bone, so that they can be screwed into the bone.
  • a guide rod is connected, in such a way that it extends approximately parallel to the manipulating pan center axis.
  • a guide element can then be arranged, which is used to guide a cutter drive axle or a pan impaction instrument serves.
  • FIG. 10 shows from left to right the following parts: 11 pelvic bones 12 acetabulum 13 Proximal section of a femur within which a Manipulierraspel not shown is fixed 14 Proximal end of the manipulation rasp placed inside the femur 15 prosthesis neck 16 Manipulatory joint head, which is attached to the prosthesis neck in a conventional manner, in particular by means of a so-called "plug-cone connection" 17 anchored in the pelvic bone 18 Attachable to a manipulation pan guide block for the guide rod 17th 20 Manipulation pan with retaining bracket 19 for the guide block 18th 24 Alignment 25 Cutter drive axle 26 rotating sleeve 27 Pan impactor 28 cutter head
  • FIG. 1 Initially, the femoral neck is reflected and, starting from the resection plane, a manipulation rasp is inserted into the femur, at the neck of which a manipulating condyle 16 is plugged.
  • the manipulating condyle 16 includes a spherical portion 21 over which a circumferentially extending shoulder 22 projects radially outward. This shoulder 22 is used for correspondence with the opening edge 23, the manipulating pan 20 accordingly FIG. 2 , In a "zero position", the distance of the shoulder 22 from the opening edge 23 over the circumference of the opening edge 23 is about the same size. Starting from this zero position, the femur 13 together with the manipulating joint head 16 is moved in all anatomically conceivable directions, as described above. Due to this movement, the collision between the shoulder 22 and the opening edge 23 of the manipulation cup 20 is very likely to occur at several points, with the result that the manipulation cup 20 is then aligned correspondingly within the acetabulum.
  • the aligned position of the manipulation cup 20 must be retained for proper alignment of both the bone cutter and the cup impactor.
  • the manipulation cup 20 is connected via a mounting bracket 19 to a guide device in the form of a guide block 18, which has a guide bore whose axis lies outside the collision area with the manipulation cup and is directed onto the pelvic bone 11.
  • guide bore 17 is a guide rod according to the Figures 3 and 4 passed.
  • the guide rod 17 has at its end facing the bone 11 a thread 29, by means of which the guide rod 17 can be screwed into the bone 11 and fixed therein.
  • the guide rod 17 is, of course, screwed into the bone 11 only after alignment of the manipulation cup 20, so that so that the position of the manipulation cup can be held within the acetabulum.
  • the manipulation pan is correspondingly FIG. 5 folded away from the guide block 18 and removed from the acetabulum.
  • the Ausrichtlehre 24 accordingly includes a guide rod 17 associated guide sleeve to which an arm, here bracket 31 is attached. At the free end of the bracket 31, a straightening plate 32 is formed. This directional plate 32 is provided with markings 33, with a mean zero mark and two tolerance marks ⁇ 5 °. These markings are marked “0 °” and "5 °” in FIGS. 6 and 7.
  • This alignment gauge is used for alignment of a first bone cutter with hemi-spherical milling head 28 and milling cutter drive axis 25.
  • milling head or its drive axis 25 this is in full or gap-free contact with the tilted to the milling axis 25 about the guide rod 17 directional plate 32nd and parallel to this in a position corresponding to a predetermined mark, preferably predetermined zero position "0 °" pivoted, as this FIG. 7 good.
  • a sleeve 26 is mounted on the cutter drive axis 25, within which the drive shaft 25 is rotatably mounted and bring the directional plate 32 in gap-free plant and Durable while milling, as well as this FIG. 8 recognize.
  • the acetabulum may be milled in a conventional manner.
  • the hemi-spherical cutter head 28 is located Thanks to the guide rod and alignment gauge 24 in a position corresponding to the previously adjusted anatomically correct position of the manipulation cup 20th
  • a marking 33 extending in the longitudinal direction thereof on the rotary sleeve 26. This marking is preferably brought into alignment with the zero mark "0 °" on the alignment plate 32. Subsequently, then the milling process can be performed to obtain a suitable bearing shell for insertion of the acetabulum. The acetabulum is ultimately either screwed into this cup or anchored with so-called. "Press-fit”.
  • the final to be implanted acetabulum 34 taken After milling the bearing shell in the acetabulum is by means of already using the FIG. 9 and 10 27, the final to be implanted acetabulum 34 taken, of course, it must be ensured that the acetabular cup is taken so that it ultimately occupies a position corresponding to the manipulation cup 20. Therefore, the pan impaction instrument 27 must be aligned as well the bone cutter or its drive axle. The corresponding orientation of the impactor 27 is in FIG. 9 shown. Again, therefore, the connection axis between the impact head and beater end is brought into gap-free contact with the directional plate 32, and preferably at the same mark as the cutter drive axis. Then it is ensured that the acetabular cup 34 is aligned anatomically aligned in the previously milled out bearing shell of the acetabulum.
  • FIG. 11 is again the manipulation pan with guide block for the guide rod 17 shown in a perspective side view.
  • the guide bore in the guide element 30 is shown in dashed lines and provided with the reference numeral 36.
  • the guide member 30 is how FIG. 10 , but also FIG. 5 can be seen from the headband 19 hinged.
  • the connection between the retaining clip 19 and guide block is preferably designed as a latching connection.
  • a modified embodiment of a Ausrichtlehre 24 is described, which is characterized on the one hand in that the guide member 30 has two through holes 42 for receiving two mutually parallel guide rods 17.
  • the alignment gauge 24 is characterized according to FIG. 12 nor by the fact that the directional plate 32 is bent in a U-shape, wherein the space between the two plate legs 37, 38 for receiving the cutter drive axis 25 and / or the Pfanneneinschlaginstruments 27 is used. These instruments are between the two plate legs 37, 38 only in a plane parallel thereto pivotable according to the double arrow 39 in FIG. 12 , The location of the alignment gauge 24 relative to the acetabulum is clearly determined by the arrangement of two guide rods.
  • the guide element 30 still has a locking screw 41 for fixing the alignment gauge 24 on the guide rods 17. Due to the use of two guide rods 17, it is of course also necessary to form the manipulation pan 20 associated guide block 18 with two through holes 42 for the guide rods 17, as well as in FIG. 12 is shown.
  • the embodiment according to FIG. 12 allows - as stated above - an angular correction of the cutter drive axis and / or the Pfannen- Einschlaginstruments only in one plane.
  • the guide rods 17 may have different lengths. They also preferably again have a thread 29 at the bone-side end.
  • guide rods 17 are removed from the bone again.
  • guide rods 17 are preferably used so-called. "Kirschner wires”.
  • manipulation pan associated guide block 18 must be adapted to the use of two guide rods 17, as well as in FIG. 12 is shown (guide block 18 with two through holes 36 for the rods 17).
  • manipulating condyle including manipulation rasp
  • the hip joint can be reassembled in a conventional manner. Due to the described manipulation or alignment, it is then ensured that a collision between the neck of the prosthesis and the opening edge of the acetabular cup 34 is excluded.
  • FIG. 13 shows a modified embodiment of a device for holding the aligned position of the manipulation pan 20, said device having three fixing rods 110, 111, 112 which extend through a holding device 118, in each case at an angle to each other.
  • the fixing rods 110, 111, 112 have at the end portions anchored in the bone screw thread 129, so that they are screwed into the bone 11.
  • the holding device 118 has in the present case two rows of holes 113, 114 for the fixing rods 110 ff, so that a sufficient selection for an optimal placement of the fixing rods 110 ff in the bone 11 is present.
  • the holding device 118 serves to connect a guide rod 117 such that it is approximately parallel to the manipulation cup center axis 115, the in FIG. 13 is indicated by the reference numeral 115 extends.
  • a guide member 118 a in the form of a half sleeve can be attached on the guide rod 117.
  • the sleeve half 119 serves to guide a in FIG. 16 It also serves to guide or align a pan-Eintschinstruments 35, being ensured by the guide member 118 a in the form of the sleeve half 119, that the orientation of the Milling cutter drive axis and the Pfanneneinschlaginstruments that of the manipulation pan 20 corresponds.
  • the manipulation cup center axis 115 coincides with the longitudinal axis of the cutter drive axis and the longitudinal axis of the ladle impactor.
  • the serving as a guide member sleeve half 119 is connected via a flat bracket 131 with the guide rod 117.
  • the connecting bracket 131 is adjustable in length in the illustrated embodiment.
  • a sleeve half 120 is also arranged as Aufsteck- and shoe.
  • the guide member 118 a can be easily placed on the guide rod 117 and move along the same.
  • FIGS. 14 and 15 are still two alternative embodiments of a manipulating joint head 116 on the one hand and 216 on the other hand shown. Both rod ends are attached to the neck 121 of a manipulating rasp 126.
  • the Manipulierraspel 126 is placed within the proximal end of a femur 13, not shown.
  • the longitudinal axis of the pin-like neck 121 corresponds to the femoral neck axis and is indicated by the reference numeral 123.
  • the manipulation cup 20 comprises a metal outer shell 124, on which the retaining clip 19 is formed, as well as an inner plastic shell or an inlay 125. In this respect, the manipulation cup 20 corresponds in terms of its structure to a permanently implantable acetabular cup.
  • Illustrated embodiment serve as a means for aligning the manipulation cup 20 in the acetabulum 12 optical detection means 122.
  • the optical detection means 122 is formed as an over the circumference of the sphährischen part of the manipulating condyle 116 extending notch or groove. This extends in the present case perpendicular to the condyle center axis 127, which in the embodiment according to FIG. 14 coincides with the femoral neck axis 123.
  • the notch 122 extending beyond the circumference of the spherical portion of the manipulating condyle 116 lies within the complementary bearing surface of the manipulating cup 20 when the condyle center axis 127 of the manipulating condyle 116 coincides with the manipulating cup center axis. Only by relative pivoting of the manipulating joint head within the manipulating pan 20, the peripheral notch 122 is visible. This is a sign that the manipulation cup 20 is correctly aligned.
  • the manipulating condyle or its spherical part and the manipulation pan have mutually corresponding markings extending in each case in the circumferential direction in order to be able to correctly align the manipulation pan around the femoral neck axis 123 as well.
  • the possible movements of the manipulation cup 20, which are universal joint movements, are in FIG. 14 marked with the double arrows 128, 129.
  • FIG. 15 A third embodiment of means for aligning the manipulation cup 20 in the acetabulum 12 is shown in FIG. 15 shown schematically.
  • the alignment of the manipulation pan 20 by interaction of a in a plane perpendicular to the condyle center axis 127 extending circumferential shoulder 222 with an obliquely to the condyle center axis 127 extending receptacle for the neck 121 of the manipulating rasp 126, whose - as already mentioned - longitudinal axis itself extends parallel to the femoral neck axis 123.
  • the correct orientation of the manipulation cup 20 is obtained when the mentioned peripheral shoulder 222 is flush with the peripheral ring surface 223 of the manipulation cup 20 and the inlay 125 thereof.
  • the last two embodiments therefore have optical detection means for aligning the manipulation cup. They are easy and reliable to handle.
  • the manipulating condyle is oriented relative to the Manipulierraspel 126 in a predetermined manner, ie, the condyle center axis 127 points in a predetermined direction. Only then it is ensured that the task initially posed is solved in the final implant.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Transplantation (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Vascular Medicine (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Pathology (AREA)
  • Dentistry (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
  • Radiation-Therapy Devices (AREA)

Claims (24)

  1. Accessoire pour l'implantation d'une prothèse de la hanche, comportant une cavité de manipulation (20), une tête articulée de manipulation (16 ; 116, 216) et comportant un dispositif (17) destiné à immobiliser la position ajustée de la cavité de manipulation (20), caractérisé en ce que la tête articulée de manipulation (16 ; 116, 216) est munie de moyens (22 ; 122 ; 222 ; 223) pour ajuster la cavité de manipulation (20) dans le cotyle (12), et en ce que le dispositif (17) destiné à immobiliser est réalisé de telle sorte qu'au moyen de celui-ci, une fraise à os (28) et/ou un impacteur (27) peuvent être ajustés pour la mise en place de la pièce acétabulaire (34).
  2. Accessoire selon la revendication 1, caractérisé en ce que la tête articulée de manipulation (16) comporte un épaulement (22), qui s'avance radialement vers l'extérieur au-delà de la partie sphérique (21) et qui correspond au bord d'ouverture (23) de la cavité de manipulation (20) pour l'ajustement de celle-ci dans le cotyle (12).
  3. Accessoire selon la revendication 2, caractérisé en ce que l'épaulement (22) est défini par des tronçons d'épaulement disposés en étant répartis sensiblement uniformément sur le pourtour.
  4. Accessoire selon l'une quelconque des revendications 1 à 3, caractérisé en ce que pour former le dispositif destiné à immobiliser la position ajustée de la cavité de manipulation (20), on utilise une tige de guidage (17) pouvant être fixée dans l'os (11) et coopérant avec un dispositif de guidage (18) disposé dans la cavité de manipulation (20).
  5. Accessoire selon la revendication 4, caractérisé en ce que la tige de guidage (17), au niveau de la zone d'extrémité apte à être ancrée dans l'os (11), comporte un filetage (29), de telle sorte qu'elle peut être vissée dans l'os (11).
  6. Accessoire selon la revendication 4 ou 5, caractérisé en ce que le dispositif de guidage (18) sur la cavité de manipulation (20) comporte une pièce (bloc de guidage 18 ou manchon de guidage), qui est reliée à la cavité de manipulation (20) par l'intermédiaire d'un bras (19) et qui comporte une forure (36) destinée à recevoir et à guider la tige de guidage (17).
  7. Accessoire selon l'une quelconque des revendications 4 à 6, caractérisé par un gabarit (24), qui peut être fixé sur la tige de guidage (17), en particulier peut être emmanché sur celle-ci, et qui est destiné à ajuster une tête de fraise (28) ou l'axe d'entraînement (25) de celle-ci, de telle sorte que l'ajustement de la tête de fraise (28) correspond à celui de la cavité de manipulation (20).
  8. Accessoire selon la revendication 7, caractérisé en ce que le gabarit d'ajustement (24) comporte un bras, en particulier un étrier (31), qui peut être emmanché sur la tige de guidage (17) et sur l'extrémité libre duquel est disposée une plaque de référence (32), en particulier une plaque de référence (32) munie de repères (0° ; ± 5°), destinée à ajuster l'axe d'entraînement (25) de la fraise, sachant que pour l'ajustement de l'axe d'entraînement (25) de la fraise, on fait pivoter celui-ci pour venir en appui complet, c'est-à-dire sans interstice, contre la plaque de référence (32) et parallèlement à celle-ci, notamment parallèlement à celle-ci dans une position correspondant à un repère (0° ; ± 5° ; 40) prédéfini, en particulier dans la position zéro prédéfinie.
  9. Accessoire selon la revendication 8, caractérisé en ce que ledit accessoire comporte une tête de fraise (28) avec un axe d'entraînement (25) de la fraise, sur laquelle peut être emmanchée un manchon (26), à l'intérieur duquel l'axe d'entraînement (25) est monté rotatif et sur lequel la plaque de référence (32) peut être amenée en appui complet, c'est-à-dire sans interstice, et peut être maintenue pendant le fraisage.
  10. Accessoire selon l'une quelconque des revendications 1 à 9, caractérisé par un impacteur (27), qui peut être ajusté sur la plaque de référence (32) du gabarit d'ajustement (24) de la même manière que la tête de fraisage (28) ou l'axe d'entraînement (25) de celle-ci.
  11. Accessoire selon l'une quelconque des revendications 1 à 10, caractérisé en ce que la cavité de manipulation (20) est munie d'un dispositif de guidage (18) pour deux tiges de guidage (17) aptes à être fixées parallèlement entre elles dans l'os (11) (figure 12).
  12. Accessoire selon la revendication 11, caractérisé en ce que le gabarit (24), destiné à ajuster la tête de fraisage (28) ou l'axe d'entraînement (25) de celle-ci, comporte deux forures débouchantes (42) pour l'emmancher sur les tiges de guidage (17) fixées dans l'os.
  13. Accessoire selon l'une quelconque des revendications 8 à 12, caractérisé en ce que la plaque de référence (32) du gabarit d'ajustement (24) est pliée en forme de U, l'espace entre les deux branches (37, 38) étant destiné à recevoir l'axe d'entraînement (25) de la fraise et/ou l'impacteur (27).
  14. Accessoire selon la revendication 13, caractérisé en ce que la branche (37) orientée vers l'opérateur, en particulier la branche supérieure, comporte sur la face frontale des encoches (40) formant des marquages pour l'ajustement de l'axe d'entraînement (25) de la fraise et/ou de l'impacteur (27) parallèlement à la plaque de référence (32) ou aux branches (37, 38) de celle-ci.
  15. Accessoire selon l'une quelconque des revendications 1 à 14, caractérisé en ce que la tête articulée de manipulation (16) peut être fixée sur le manche (15) d'une râpe de manipulation (14), en particulier peut être emmanchée sur celui-ci.
  16. Accessoire selon la revendication 1, caractérisé en ce que pour les moyens destinés à ajuster la cavité de manipulation (20) dans le cotyle (12), on utilise des moyens de détection (122 ; 222) optiques.
  17. Accessoire selon la revendication 16, caractérisé en ce que la partie sphérique de la tête articulée de manipulation (116) comporte un marquage, en particulier une encoche (122), rainure ou élément similaire, qui s'étend au moins en partie sur tout le pourtour et qui s'étend à l'intérieur d'un plan qui est situé perpendiculairement ou selon un angle prédéfini par rapport à l'axe médian (127) de la tête articulée.
  18. Accessoire selon la revendication 1, caractérisé en ce que pour les moyens destinés à ajuster la cavité de manipulation (20) dans le cotyle (12), on utilise un épaulement périphérique (222), qui s'étend dans un plan perpendiculaire à l'axe médian (127) de la tête articulée, en association avec un logement, orienté en oblique par rapport à l'axe médian (127) de la tête articulée et destiné à recevoir le manche (121) d'une râpe de manipulation (126), dont l'axe longitudinal est parallèle à l'axe du manche (123).
  19. Accessoire selon l'une quelconque des revendications 1 à 3 et/ou 16 à 18, caractérisé en ce que pour le dispositif destiné à immobiliser la position ajustée de la cavité de manipulation (20), on utilise au moins une, en particulier trois tiges de fixation (110, 111, 112), laquelle ou lesquelles s'étend(ent) à travers un dispositif de fixation (118) pour la cavité de manipulation (20).
  20. Accessoire selon la revendication 19, caractérisé en ce que la ou les tiges de fixation (110, 111, 112), au niveau des zones d'extrémité pouvant être ancrées dans l'os, comportent un filetage (29), de telle sorte qu'elles peuvent être vissées dans l'os (11).
  21. Accessoire selon la revendication 19 ou 20, caractérisé en ce qu'une tige de guidage (117) peut être attachée au dispositif de fixation (118), de telle sorte que ladite tige de guidage est sensiblement parallèle à l'axe médian (115) de la cavité de manipulation.
  22. Accessoire selon la revendication 21, caractérisé par une tige de guidage (117) pouvant être fixée ou emmanchée sur l'élément de guidage (118) pour un axe d'entraînement (25) de la fraise ou un manchon (26) qui s'étend autour de celui-ci, ainsi que pour un impacteur (35), sachant que l'élément de guidage (118) permet de garantir que l'ajustement de l'axe d'entraînement (25) de la fraise et de l'impacteur (35) correspond à celui de la cavité de manipulation (20).
  23. Accessoire selon la revendication 22, caractérisé en ce que l'élément de guidage (118) est un manchon ou un demi-manchon (119), disposé sur un étrier (131) ou un élément d'assemblage similaire.
  24. Accessoire selon la revendication 23, caractérisé en ce que l'étrier (131) est réglable en longueur.
EP03702385A 2002-01-10 2003-01-03 Accessoire pour l'implantation d'une endoprothese de la hanche Expired - Lifetime EP1463466B1 (fr)

Applications Claiming Priority (3)

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DE10200690 2002-01-10
DE10200690A DE10200690B4 (de) 2002-01-10 2002-01-10 Hilfsmittel zur Implantation einer Hüftgelenkendoprothese
PCT/EP2003/000035 WO2003057087A2 (fr) 2002-01-10 2003-01-03 Accessoire pour l'implantation d'une endoprothese de la hanche et son procede de manipulation

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US20050107799A1 (en) 2005-05-19
US7828806B2 (en) 2010-11-09
DE10200690B4 (de) 2005-03-03
DE50312238D1 (de) 2010-01-28
US8556898B2 (en) 2013-10-15
ATE451893T1 (de) 2010-01-15
WO2003057087A2 (fr) 2003-07-17
WO2003057087A3 (fr) 2003-12-11
EP1463466A2 (fr) 2004-10-06
US20110087230A1 (en) 2011-04-14
DE10200690A1 (de) 2003-10-02

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